title: A prospective randomized study to evaluate the effect of hyaluronic acid sperm selection on the intracytoplasmic sperm injection outcome of patients with unexplained infertility having normal semen parameters.
abstract: OBJECTIVE
  Sperm quality plays an important role in determining embryo development and intracytoplasmic sperm injection (ICSI) outcome. Selection of competent sperm based on its ability to bind to hyaluronic acid (HA) has been suggested as one of the methods to assess sperm quality. The aim of the present study was to examine whether injection of HA bound sperm helps in improving outcome in patients undergoing ICSI with unexplained infertility having normal semen parameters.
  
  
  METHODS
  Patients with unexplained infertility having normal semen parameters in accordance with WHO 2010 criterion, undergoing their first IVF-ICSI cycle were enrolled during the course of the study.156 patients were prospectively randomized after oocyte retrieval and were assigned to either the ICSI group, where sperm selection for injection was based on visual assessment, or the PICSI group, where sperm were selected based on their ability to bind to HA. Only fresh embryo transfers were included in the analysis.
  
  
  RESULTS
  There was no difference in the fertilization rates, number of top quality embryos and clinical pregnancy rates between the ICSI and PICSI groups (65.7 % vs 64.7 %; 45.8 % vs 43.6 % and 35 % vs 35.2 % respectively). However, a higher pregnancy loss rate was observed in the ICSI group (25 % vs 12 %; P = 0.227) as compared to the PICSI group, but the difference was not statistically significant. Implantation rates were 22.03 % and 18.84 % in the PICSI and ICSI groups respectively. There were 22 (31 %) live births in the PICSI group and 21(26.3 %) live births in the ICSI group.
  
  
  CONCLUSIONS
  Patients with unexplained infertility having normal semen parameters may constitute a patient group which does not benefit from this sperm selection method. A larger study may be necessary to establish a relationship between PICSI and pregnancy loss rate in patients undergoing IVF with unexplained infertility.
authors.affiliation: Center of IVF and Human Reproduction, Institute of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, 110060, India, gaurav1979@hotmail.com.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Majumdar
authors.forename: Abha
authors.initials: A
authors.lastname: Majumdar
mesh_terms: D000328:Adult; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D006820:Hyaluronic Acid / Q000378:metabolism*; D007246:Infertility / Q000209:etiology*; D008297:Male; D054315:Oocyte Retrieval; D009865:Oocytes / Q000166:cytology* / Q000378:metabolism; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D012661:Semen / Q000737:chemistry* / Q000166:cytology; D020554:Sperm Injections, Intracytoplasmic / Q000009:adverse effects*; D013094:Spermatozoa / Q000166:cytology / Q000378:metabolism*
chemical_list: D006820:Hyaluronic Acid